Category: anxiety and CBT

Cognitive psychologists, who like to think of us humans as very logical and rational, say that anxiety is useful because it sends a signal to the brain saying “change direction!” whenever we’re doing (or about to do) something dangerous. In this way, it acts in a similar way to pain. Pain itself is not the real problem but a signal that there is one – it might be indicating a bone fracture or appendicitis, for example. Pain gets our attention, and anxiety acts in a similar way to indicate that there’s something wrong.

Aaron Beck, the father of cognitive therapy (and grandfather of CBT), said that we are constructed “in such a way as to ascribe great significance to the experience of anxiety”, so that we’ll feel compelled to do something about it. It’s such an uncomfortable feeling, in other words, that we’ll stop doing whatever is causing anxiety, and so remain safe.

But this isn’t always the case. It’s entirely possible to experience anxiety but be unable to identify its cause. In fact, many people suffering from high levels of generalised anxiety don’t know why they feel this way, and may feel bad about themselves for this perceived incompetence. So what’s happening in these cases?

Our primitive brain decides

As the great trauma expert Peter Levine pointed out, there’s a difference between anxiety designed to produce a volitional response (e.g. stop driving so fast) and one that’s designed to produce an involuntary response or reaction. And here lies the answer for the more mystifying types of anxiety – they stem from an area of the brain that controls all our involuntary actions (such as breathing and heart rate). This is the sub-cortical section of the brain, which also houses our basic animal instincts, including the supreme instinct to survive. When this part of the brain is triggered into perceiving a survival threat, it causes an instant, non-volitional reaction. It’s super-fast, because it’s not a good idea to be wondering about whether that car heading straight for you might swerve at the last minute. You see it coming, and you’ve leaped out of the way before thinking about it. This is very different to the volitional anxiety that Beck was talking about, which might make you carefully step back from a cliff.

The fast-reacting, involuntary kind of response that sees us jump away from a snake comes from the primitive, sub-cortical part of our brain that we share with other mammals. It assesses any threat in the environment and forces us into taking involuntary action if survival demands this. But our animal brain (the ‘reptilian’ and limbic parts of the brain) does more than this – it also immediately assesses whether we can escape or fight back, or are trapped and can do nothing.

This unconscious decision – about whether to fight, take flight or freeze – becomes known to us through our reaction to the threat. If our animal brain has decided we can fight this or make a run for it, we may experience symptoms such as a tightening sensation across the neck, shoulders, arms and legs, rapid heartbeat, and a feeling of being ‘ready for action’. We have an active pattern of coping, and a set of actions that can arise and be completed.

But if our animal brain has decided that fighting or running won’t work, what happens is that our active forms of defence (fight/flight) are aborted. They arise but are quickly switched off – and it is this incompletion of the active coping mechanism that causes anxiety to follow from the event. We freeze, which is one of the last defences of any animal, and lock down any movements that we would wish to make to save ourselves. These incompleted responses, such as running or punching, are denied and locked down. Anxiety that seems to have ‘no reason’, is essentially the energy wrapped up in these unrealised defensive responses. The anxiety stems from times when we wanted to fight or run, but were trapped or overwhelmed, and had to contain our active defences, instead falling back on passive ones (the freeze response or even thanatosis, where the body appears to be dead).

Anxiety doesn’t arise from dangerous situations, but from a feeling of being unable to cope with them and take action to get out of them. Levine says that “ultimately we have only one fear, the fear of not being able to cope, of our own un-copability. Without active, available, defensive responses, we are unable to deal effectively with danger and so we are, proportionately, anxious”. And that anxiety does not go away over time. It remains in the mind and body.

This kind of anxiety can either erupt occasionally in the event of being triggered, or operate as a kind of background hum all the time.

It also can be said to result from trauma – which involved a feeling of being overwhelmed and unable to escape. But we’d remember that, wouldn’t we? Confusingly, not always. Sometimes the trauma occurred many years ago, in childhood (such as being bullied at school or frightened by an angry parent) or stemmed from an event that we remember but don’t realise has affected us in a very deep way (such as caring for a loved one when they were dying). Traumatic memories are different: they are not processed fully or correctly at the time (because they were too overwhelming to the system) and so they are inadequately processed and maladaptively stored. Instead of fitting into the autobiographical memory of our everyday lives, they remain ‘unfiled’ in some way, and continue to intrude, unbidden, into our lives at odd moments.

Which means that it’s quite possible to feel highly anxious, while not knowing why. But the not-knowing does not mean that the fear is illogical or unreachable, or that the sufferer is behaving stupidly in some way. Quite the opposite – the person suffering from this form of anxiety has had to be immensely brave at some point in their lives. This is where therapy can play a vital role, in helping someone to realise and release the emotions and actions that were put aside for survival, and genuinely let go.

‘A person suffering from this type of anxietyhas had to be incredibly brave at some point in their lives’

In the simplest of terms, the human brain is made up of three parts that evolved at different times over millions of years. This is the theory of the Triune Brain, developed by Paul MacLean in the 1960s, and it may be the most useful brain theory for those of us without a degree in neuroscience who nevertheless want to understand something about how the brain works and why we act like we do. It also holds the key for learning how to regain calm from a state of high anxiety or even panic.

In MacLean’s model, the oldest part of the brain is known as the reptilian brain. This developed in animals over 100 million years ago, and not only does that ancient brain still operate in our nervous system, it’s often running the show. Which is not always useful, given that this part of the brain is instinctive, automatic, lightning fast, and hell-bent on survival (it’s the part that will make you swerve away from a falling object before you’ve even consciously noticed it). The reptilian brain controls the involuntary systems of the body (breathing, heartbeat, organ functioning, body temperature) and it’s also responsible for triggering our fight/flight/freeze responses. It gets scared or angry fast. It’s territorial, aggressive and horny – it wants to stay alive and to reproduce. It’s obsessive, compulsive, and easily scared (its job is to keep us alive), so it not only holds us back from applying for new jobs or pursuing our dreams – it can keep us held in a state of anxiety.

Which means that if you’re struggling with anxiety, the reptilian brain needs soothing. But to know how best to do this, it’s necessary to know something about the other two evolutionary parts of the brain: the limbic system and the neocortex.

Anxiety and the reptilian brain

We share the reptilian brain with reptiles and birds, but the limbic system (sometimes called the ‘limbic brain’) is the part we have in common with mammals like dogs and horses. This evolutionary addition emerged in the first mammals, bringing a huge increase in brainpower and the ability to feel emotions, experience motivation, store long-term memory and be able to learn. It contains the amygdala, which is sometimes referred to as the ‘fear centre’. The limbic system is tightly connected to the newest part of the brain – the neocortex.

The neocortex evolved in primates around 40,000 years ago, which is a blink of the eye in evolutionary terms. This is the ‘clever’ part of the brain – it allows us to do complex things that mammals and reptiles can’t manage, such as advance planning and intricate social interactions. The neocortex is often referred to as the ‘executive functioning’ part of the brain, because it figures things out, makes reasoned judgements, calculates and handles complex concepts. It also provides us with imagination and creativity. Our neocortex is three times larger than would be found in a similar-sized primate, which perhaps explains why we’re top of the food chain and have populated the entire globe, while monkeys and chimps are still swinging from trees.

And here’s the thing: the neocortex can temper the reactive response of the reptilian and limbic brains.

When your reptilian brain leaps off the path after seeing a coiled something, your neocortex checks it out, realises it’s a rope not a snake, and sends out ‘it’s ok!’ signals to the whole nervous system. The neocortex can help us to reason our way out of an anxious or fearful feeling. The reptilian brain might get jumpy in the dark, but the neocortex checks for time, place and contex, and says ‘It’s just 3 a.m. and you’re in bed at home – everything is fine’. It’s this cognitive ability that is used in CBT (Cognitive-Behavioural Therapy) to reduce constant worrying and high levels of anxiety through examining thoughts and changing unhelpful thought patterns and associations.

The CBT isn’t working! I’m still anxious!

The reason that CBT is often unable to help in a state of high anxiety is this: once our reptilian brain is triggered into ‘thinking’ there’s a survival threat, the neocortex effectively goes off-line. This is because it is not helpful to be wondering whether that’s really a rope or a snake on the forest path – you need to act. Fast. In a survival threat situation, the reptilian brain leaps into action and saves us, effectively shoving the neocortex and its slower thinking out of the way. Which means that we lose the capacity for careful, reasoned judgement, and now we’re acting instinctively. Like an animal.

If you find yourself living in a permanent state of fear, anger or very high stress, your mind and body will be reading this as a struggle for survival. And when that’s the interpretation of your current situation, control will veer between the reptilian and mammalian (limbic) parts of the brain. You won’t have access to your human, reasoning part, the neocortex. You may not be able to process emotions either, while the reptilian brain is screaming ‘RUN!’ (which may not be helpful in the middle of a work appraisal). In this situation, the world may be experienced as overwhelming, out of control and full of danger. What you need, in this situation, is to use one of the reptilian brain’s own tools.

Consciously taking hold of an involuntary process

The reptilian brain controls all our involuntary body processes, such as our heartbeat. And most of these are beyond our control, so they’re operating in a one-way system – they automatically (unconsciously) control parts of our bodies and we cannot consciously gain control over them. Except for one thing – the breath. Breathing is a function of the reptilian brain that we can take conscious control over, and as we do so, we can affect the other involuntary systems that the reptilian brain is controlling. The fight/flight/freeze response will show up in many ways, including fast, shallow breathing from the high chest area. But if you consciously take hold of the breath and change it – making it slower and deeper – you will be taking hold of the entire fight/flight/freeze response.

Slow the breath and you’ll slow the heartbeat. Slow that, and you’ll begin to bring the fight/flight system under control. This calms the limbic brain and allows the neocortex (which disengaged during the survival response) to come back online. Now you’re in a position to see where you are and what’s actually happening – you can assess the real level of danger. You can think clearly again.

The breath is a tool that’s always with you and it’s inconspicuous to use. You could be standing on a train packed with passengers and bring the breath into use to calm the reptilian brain without anyone noticing. You may even use this system unconsciously at times already to relieve stress, such as when you let out a huge sigh or a long deep breath when things begin to feel stressful.

How to calm the reptilian brain

In a moment of crisis, when you feel triggered into jumpy over-reactivity, stop what you’re doing and take your mind off your current stream of thought. Direct all your thinking to the breath and take control of it. Breathe in and out very slowly, drawing the breath right down to the belly, so that it expands (as though you’re blowing up a balloon in your belly). Breathe in through your nose (over a count of about four seconds), hold the breath for one or two seconds, then very slowly breathe out again, over a count of six to eight seconds. Breathe out through your mouth as though you’re cooling hot soup on a spoon by your mouth. Slowly and smoothly.

Notice the difference in any shakiness you were feeling, as you bring the fight/flight/freeze response under control. Keep breathing like this until you notice that you are able to think more clearly again (a sign that the neocortex has reconnected). In a case of real danger, like an oncoming train or tiger, we need to disengage the slow-responding, “hmm, wonder what that is?” type of thought that the neocortex engages in, but for daily life, we benefit from its consideration. This is our higher, human brain, that allows us to function happily and healthily in a complex world. So if the reptilian brain gets triggered into driving the system, simply move it gently into the back seat again by using one of its own tools – the extraordinarily effective breath.